Isolated Kaposi Sarcoma of the External Ear in an Immunocompromised Host: A Case Report

A vascular neoplasm linked to HHV-8 infection, Kaposi sarcoma (KS) is common in immunocompromised patients, notably people living with HIV. Isolated external ear involvement is uncommon and may present clinically as keloids, cysts, or infections.

A 31-year-old man presented with a one-month history of ipsilateral dacryocystitis and a rapidly growing, painful right auricular mass. The auricular lesion was initially presumed to be a sebaceous cyst during his emergency room evaluation, with actively draining purulent material. Labs showed severe pancytopenia with anemia of chronic disease, and his HIV screening test was newly reactive. Otolaryngology described an exophytic mass on the superior pinna with concern for superinfection. Local wound care was recommended, with excision planned once inflammation improved. CT showed a heterogeneous, exophytic soft-tissue mass measuring 2.2 × 1.9 cm involving the pinna. The lesion was excised, and pathology was consistent with classic KS morphology. Pathology showed a single 2.5 cm spindle cell lesion. Immunohistochemistry supported the diagnosis of KS, with tumor cells positive for HHV-8, CD31, and CD34. Mitotic activity was 21 per 10 highpower fields. Margins were negative, and no lymphovascular invasion was seen. The dacryocystitis resolved with antibiotics.

Kaposi sarcoma of the ear is uncommon and often appears without systemic symptoms, which can delay diagnosis. Purulence and tenderness may be mistaken for a simple infection, and a keloid-like morphology can also mislead clinicians. This case highlights the similarity of these lesions, making biopsy essential to differentiate Kaposi sarcoma from more common benign or infectious ear conditions. Clinicians should consider Kaposi sarcoma of the external ear when evaluating persistent or unusual ear masses, especially in patients with weakened immune systems. Early tissue diagnosis and teamwork among specialists may lead to improved outcomes.